目的 研究2型糖尿病(type 2 diabetes mellitus,T2DM)患者代谢指标与甲状腺功能的变化及其相关性.方法 选择2010年11月～2011年4月首都医科大学附属北京朝阳医院T2DM患者409例(T2DM组)及健康者85例(对照组),比较两组间代谢指标体重指数(BMI)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)；稳态模型评估2胰岛素抵抗指数(HOMA2-IR)和尿酸(UA)及甲状腺功能指标游离三碘甲状腺原氨酸(free tri-iodothyronin,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(FSH).根据HbA1c将T2DM组分为血糖控制理想组(DM A组,n=71)和血糖控制不理想组(DM B组,n=338),研究T2DM患者中影响甲状腺功能指标的因素.结果 T2DM和对照组BMI、HbA1c、TC、LDL-C、TG、UA、FT3和FT3/FT4比较,差异有高度统计学意义(P＜0.01)；两组HDL-C、FT4和TSH比较,差异无统计学意义(P＞0.05).对照组FT3[(3.07±0.30)ng/L]、FT3/FT4(0.269±0.039)均高于DM A组[(2.71±0.42)ng/L、(0.235±0.040)]、DM B组[(2.42±0.43)ng/L、(0.209±0.040)],DM A组FT3、FT3/FT4均高于DM B组,差异均有高度统计学意义(均P＜0.01).HbA1c与FT3及TSH相关,差异有统计学意义(β=-0.247、0.150,P=0.000、0.002)；BMI、HbA1c、TC、UA与FT4相关,差异有统计学意义(P＜0.05).结论 T2DM常伴随甲状腺功能异常,随着HbA1c升高而FT3及FT3/FT4则递减,甲状腺功能异常与T2DM密切相关并影响其发展.%Objective To investigate the relationship between metabolism indices and thyroid function parametersin in patients with type 2 diabetes mellitus (T2DM).Methods 409 patients with T2DM (T2DM group) and 85 healthy patients (control group) from November 2010 to April 2011 in Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled; Metabolism indices such as body mass index (BMI),glycosylated hemoglobin (HbA1c),TC,LDL-C,high density lipoprotein cholesterin (HDL-C),triglycerides (TG),homeostasis model assessment 2-insulin resistance index (HOMA2-IR),uric acid (UA) and thyroid function parameters free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH) were compared between two groups.The T2DM group was divided into ideal blood sugar control group (DM A group,n =71) and unideal blood sugar control group (DM B group,n =338) according to HbA1c level.The main influencing factors of the thyroid function parameters in T2DM patients were analyzed.Results The differences of BMI,HbA1c,TC,LDL-C,TG,UA,FT3,FT3/FT4 in the two groups were statistically significant (P ＜ 0.01); the differences of HDL-C,FT4,TSH in the two groups were not statistically significant (P ＞ 0.05).FT3,FT3/FT4 in control group [(3.07±0.30) ng/L,(0.269±0.039)] were all higher than those in DM A group [(2.71 ±0.42) ng/L,(0.235±0.040)] and DM B group [(2.42±0.43) ng/L,(0.209±0.040)],the differences were statistically significant (P ＜ 0.01).HbA1c was the influencing factor with FT3 and TSH,the differences were statistically significant (β =-0.247,0.150,P =0.000,0.002); BMI,HbA1c,TC,UA were the influencing factors with FT4,the differences were statistically significant (P ＜ 0.05).Conclusion T2DM always follow with thyroid dysfunction,with the raise of HbA1c,FT3 and FT3/FT4 decrease progressively.Thyroid dysfunction has relationship with T2DM and influence its development.
展开▼
